LECTURE 57 - gender-affirming care Flashcards
Define what is encompassed in gender-affirming care
- Addresses social, mental, and medical health needs & well-being
- Supports gender diverse people across the lifespan
- Holistic & multidisciplinary
- Family medicine, primary care, endocrinology reproductive health, sexual health, mental health, voice & communication, preventative care, chronic disease management, surgery
- Inclusive & nonjudgemental
What should be considered when recommending Fertility Preservation & Sexual Health options for transgender men?
- transgender men MAY be taking testosterone
- Possible loss of fertility - may desire to harvest & bank eggs prior to treatment
- If pregnancy occurs, high levels of testosterone may cause harm to the fetus - use contraceptives if pregnancy is a risk in any way
What should be considered when recommending Fertility Preservation & Sexual Health options for transgender women?
- transgender women MAY be taking estradiol
- Decreases sperm production, may be unable to produce healthy sperm after stopping estradiol
- May desire to bank sperm prior to starting estradiol
Describe the goals for Gender-Affirming Hormone Therapy (GAHT)
GAHT seeks to:
– Suppress endogenous sex hormone secretion determined by the person’s genetic/gonadal sex
– Maintain sex hormone levels w/in the normal range for the person’s affirmed gender
List the options for HRT for transgender men
bioidentical testosterone
injections:
– Cypionate injection (cottonseed oil)
–Enanthate injection (sesame seed oil)
Topical gel packets or pump formulation
(avoid skin contact, dry for 2 hours min.)
Patch
List the preferred options for HRT for transgender women
preferred - bioidentical 17-beta estradiol
injections:
– Valerate injection (sesame or castor oil)
– Estradiol injection (cottonseed oil)
patch
(preferred for pts who used tobacco or high risk for VTE)
tablet - oral / sublingual
List side effects of testosterone
Migraine headache → related to fluctuating -estrogen
Hair loss → tx w/ finasteride / dutasteride
PCOS:
Monitor for hyperlipidemia & diabetes
Acne:
Common side effect
Peaks in year 1 of tx
Screen for osteoporosis & risk of bone loss
Medical risks:
Coronary artery disease
Cerebrovascular disease
HTN
Breast / Uterine cancer
List needed lab monitoring for patients on testosterone for HRT
- CBC (for hemoglobin/hematocrit)
- Lipid profile
- Liver function tests
- Fasting glucose/HgbA1c
- Serum testosterone
- Sex hormone binding globulin/albumin
- Estradiol
List side effects of estradiol
- Hyperprolactinemia & galactorrhea
- Weight gain
- VTE risk
- Migraine
- Screen for osteoporosis and bone loss risk
Medical risks:
Breast cancer
Coronary artery disease
Choleithiasis
List alternate options for HRT for transgender women (anti-androgens)
Spironolactone
(direct anti-androgen, may suppress testosterone synthesis)
Finasteride or Dutasteride
(can be used if spironolactone is not tolerated
Block conversion of testosterone → DHT)
Bicalutamide
(may be used BUT concern for liver function abnormalities limits use)
List side effects of spironolactone
May reduce breast development due to estrogen receptor activity
(If the pt experiences this, can use estradiol only & add spironolactone later)
Orthostasis & polyuria can occur, counsel pts to take in the morning to decrease getting up at night to use the bathroom
List side effects of Finasteride or Dutasteride
Decreased libido
Erectile dysfunction (may be a desired effect)
List what should be monitored for patients taking Estradiol or Spironolactone
Renal function
Lipid profile
HgbA1c/fasting glucose
Estradiol
Potassium (spironolactone)
List alternate options for HRT for transgender women (bioidentical micronized progesterone)
CHECK FOR PEANUT ALLERGY
options:
– Medroxyprogesterone (synthetic)
oral dosing
What are the treatment options for non-binary patients?
- May be interested in individualized partial transition
- Non-standardized GAHT is increasingly used to address goals of treatment of NB individuals
List the goals of treatment for non-binary individuals
- To decrease the distress, improve QOL & mental health, & center pt desires
- Use PCC & personalized medicine
What are the general needle requirements for testosterone & estradiol injectable hormone therapies
Disposable syringe & TWO needles
What is the recommended syringe size for testosterone & estradiol injectable hormone therapies & why?
1 mL
due to small volume & need for accuracy
What is the recommended needle size for testosterone & estradiol injectable hormone therapies (drawing up injection)?
18 g - OR- 20 g
LARGER gauge to draw up injection
What is the recommended needle size for testosterone & estradiol IM injectable hormone therapies (AFTER drawing up injection)?
22 g - OR- 23 g
1 inch - OR - 1.5 inch
SMALLER gauge once injection is drawn up (switched out)
What is the recommended needle size for testosterone & estradiol SUBQ injectable hormone therapies (AFTER drawing up injection)?
25 g - OR- 26 g
5/8 inch
SMALLER gauge once injection is drawn up (switched out)
